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Conclusions recommendations

Conclusions and recommendations

It is a requirement that reports do not make recommendations about policy or practice. However, authors are encouraged to identify implications for practice or local service delivery from the findings of their research.

For example, a study on support workers should not enter the policy debate on statutory registration, but may note the association in a study between organisations with designated board-level responsibility for support workers and impact on staff engagement/retention or similar, or a study on commissioning practice should not make recommendations about structural change, but may note characteristics of high-performing organisations and teams.

Each conclusion should be worded as being derived from the evidence. For example:

"The evidence suggests that a national programme for X may meet the National Screening Committee’s criteria . . ." (not "A national programme for X is recommended . . . ")

"The accepted criteria for an X screening programme are not currently met" (not "The introduction of an X screening programme is not recommended . . . ")

"Findings from this research indicate that substitution of care by x (staff) for y (staff) may provide equivalent quality of care, but there was no evidence of cost reductions in the study groups" (not "swapping doctors for nurses is always going to be more expensive and not worthwhile")

"Research suggested a strong positive association between a particular form of incentive scheme and improved clinical processes" (not "incentives should be introduced for all staff to improve patient care")

It is perfectly acceptable and desirable to make recommendations about future research. Reports should summarise evidence and draw out the implications of that evidence for practice

Recommendations for future research should be listed in order of priority. In addition, reports must indicate how rapidly the ‘knowledge base’ in an area is developing, to help inform a decision about when it might be appropriate to update a review in the area.

Recommendations arising from research will undergo careful consideration by the advisors of commissioning bodies.

Divergent results

It will be important for authors to reflect carefully on the results of technology assessments which indicate that the findings of effectiveness and cost-effectiveness analyses do not agree. That is, where effectiveness assessment concludes that a technology is not effective, or there is not significant evidence to support a conclusion of effectiveness, but the economic analysis reports that the technology is likely to be considered cost effective. Such situations are not rare and can make the overall assessment of a technology challenging.  Authors should consider contextual and analytic factors which may contribute to apparently divergent findings between elements of their health technology assessment and make these transparent to readers.